Provider Demographics
NPI:1356788814
Name:CALDWELL, TANDRA (MS CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:TANDRA
Middle Name:
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2347 CORDOZA AVE
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-4303
Mailing Address - Country:US
Mailing Address - Phone:714-944-8809
Mailing Address - Fax:
Practice Address - Street 1:2347 CORDOZA AVE
Practice Address - Street 2:
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-4303
Practice Address - Country:US
Practice Address - Phone:714-944-8809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-23
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP19080235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist